光学相干断层扫描血管成像（OCTA）在黄斑疾病中的应用进展

光学相干断层扫描血管成像（optical coherence tomography angiography,OCTA）是一项新型、无创的成像技术,它可以对视网膜脉络膜血流进行实时成像。相比传统造影剂,OCTA更快捷、安全,并且避免了造影剂相关风险。目前,OCTA已被广泛地应用于眼科临床工作中。本文将对OCTA在黄斑疾病中的临床应用进展进行综述。     

黄斑部疾病的光学相干断层扫描

目的：观察黄斑疾病在光学相干断层扫描技术(optical coherence tomography,OCT)检查中的表现。方法：选择底镜、FFA或ICG等检查证实的40例47眼黄斑部疾病眼行OCT检测,部分病例进行定期的OCT复查。结果：40例47眼中：黄斑裂孔5眼,黄斑前膜4眼,黄斑囊样水肿8眼,中心性浆液性视网 膜脉膜病变20眼,脉络膜新生血管5眼,视网膜脱离累及黄斑部复位术后者5眼,在OCT中各有其特殊图像。     

光学相干断层扫描对黄斑劈裂的观察

目的:加深对黄斑部视网膜劈裂的了解。方法:对2005-01/2007-01间我院进行OCT检查发现黄斑部存在视网膜劈裂的患者进行了进一步的检查和分析。结果:在此期间共有符合入选条件的116眼经OCT诊断为黄斑部视网膜劈裂,其中94眼为病理性近视眼,17眼为先天性遗传性黄斑劈裂,5眼是视乳头小凹。其中视网膜劈裂可发生在视网膜神经上皮层中内、中、外三个部位,其中外层的最常见;不同原因所导致的劈裂其病变的层次和范围也各不相同。结论:黄斑部的视网膜劈裂可发生在视网膜的多个层次,对于其的认识有待进一步加强。     

光学相干断层扫描对糖尿病性黄斑水肿的诊断意义

目的:观察黄斑水肿的光相干断层扫描(OCT)图像特征;探讨糖尿病黄斑水肿与视力、糖尿病性视网膜病变分期和糖尿病病程的关系。方法:对58例(97眼)患者通过荧光血管造影分期分组,OCT测量各组厚度后,采用SPSS10.0软件进行统计学分析,分析各型黄斑水肿构成比及其与视力、糖尿病病程、分期的关系。结果:黄斑水肿的OCT图像主要包括视网膜海绵样肿胀、黄斑囊样水肿及神经上皮浆液性脱离;随糖尿病病程延长,糖尿病视网膜病变的发展,黄斑水肿构成比逐渐增加、病变加重,黄斑区视网膜厚度有增加趋势,视功能受损程度加重。结论:糖尿病性视网膜黄斑水肿的OCT图像为临床提供类似病理学的直观资料,尤其对治疗的随诊及判定预后具有重要参考价值。     

黄斑水肿的光相干断层扫描分析

目的 观察黄斑水肿的光相干断层扫描（OCT）图像特征；探讨黄斑中心凹厚度与最佳矫正视力之间的关系。 方法 对50例正常对照者以及47例54只经直接、间接检眼镜、三面镜及荧光素眼底血管造影（FFA）诊断为黄斑水肿的患眼进行OCT检查，通过黄斑中心凹的水平或垂直方向线性扫描，测量黄斑中心凹的厚度，对比分析两组受检者的黄斑形态及中心凹厚度值，根据形态学特点对黄斑水肿者的OCT图像进行分类并将其中心凹厚度与其最佳矫正视力进行相关分析。 结果 正常对照组与黄斑水肿组黄斑形态及中心凹厚度差异有显著性的意义。黄斑水肿患眼的OCT图像表现为3种特征，20只眼表现为黄斑区视网膜海绵样肿胀，占37.1%；26只眼表现为黄斑囊样水肿，占48.1%；8只眼表现为浆液性视网膜神经上皮脱离，占14.8%。黄斑水肿者黄斑中心凹厚度与其最佳矫正视力呈负相关（r=－0.569, P=0.000）。 结论 黄斑水肿的OCT图像主要包括视网膜海绵样肿胀、黄斑囊样水肿及神经上皮浆液性脱离。黄斑水肿患者的黄斑中心凹厚度明显增厚，黄斑中心凹厚度越厚，视力越差。 （中华眼底病杂志，2004，20：152-155）     

老年黄斑变性43例光学相干断层扫描分析

目的:研究老年黄斑变性的光学相干断层扫描(optical coherence tomography,OCT)特征.方法:对经眼底荧光造影(fundus fluorescein angiography,FFA)确诊的老年黄斑变性患者43例45眼,其中湿性型28例30眼、干性型15例15眼,按年龄匹配的正常人30例43眼利用OCT分别进行检测.观察黄斑部神经纤维层(nerve fiber layer of macular,MNFL)、色素上皮/脉络膜毛细血管复合层(retinal pigment epithelium/choriocapillaris,RPE/CC)及视网膜神经上皮层(retinal neurepithelium layer,RNE)的厚度变化.应用秩和检验比较其差异性.结果:MNFL厚度:湿性型老年黄斑变性组为76.5±51.7 μm、干性型老年黄斑变性组为32.5±7.6 μm、正常对照组为27.7±6.4 μm,湿性型组与其他组比较差异有显著性(P＜0.05).RNE厚度:湿性型老年黄斑变性组为307.1±130.8 μm、正常对照组为239.9±13.4 μm、干性型老年黄斑变性组为223.4±22.6 μm,湿性型组与其他组比较差异有显著性(P＜0.05).RPE/CC厚度:湿性型老年黄斑变性组为115.3±30.6 μm、干性型老年黄斑变性组为81.7±20.4 μm、正常对照组为76.4±11.5 μm,湿性型组与其他组比较差异有显著性(P＜0.05).结论:黄斑部神经纤维层厚度、视网膜神经上皮层厚度及色素上皮/脉络膜毛细血管复合层厚度随着老年黄斑变性病程的发展,其厚度增加.OCT可以作为湿性型老年黄斑变性发生与发展的监测工具之一.     

玻璃体黄斑中心凹牵拉的光学相干断层扫描分析

目的 :应用光学相干断层扫描 (opticalcoherencetomography ,OCT)定量分析玻璃体牵拉与黄斑裂孔形成的关系。探讨OCT检查对诊断特发性黄斑裂孔的意义。方法 :OCT显示为玻璃体黄斑中心凹牵拉的 18例 ( 2 0眼 )患者进行随访。垂直和水平线性OCT经过黄斑中心凹 ,分析OCT图像 ,测量黄斑厚度及玻璃体后脱离 ,定量分析黄斑裂孔与玻璃体牵拉的关系。结果 :平均年龄为 63 2± 8 4岁 ( 5 0～ 77岁 ) ,男性 2例 ,女性 16例。临床诊断为临界黄斑裂孔 9眼 ,黄斑囊肿 2眼 ,玻璃体黄斑牵拉 3眼 ,黄斑囊样水肿 3眼 ,视网膜前膜 1眼及诊断不详 2眼。首次OCT图像显示玻璃体后皮质粘连在黄斑中心凹处 ,中心凹变平或隆起 ,神经上皮间呈低反射的囊肿。未形成裂孔眼的玻璃体后脱离逐渐增加 ,中心凹的隆起度亦随之增加。随访视力显著下降 (P =0 0 0 1,配对T检验 ) ;视力与黄斑的隆起度呈负相关 (r2 =0 5 3 ,P =0 0 0 3 ,Pearson相关分析 )。 2 0眼中 8眼 ( 4 0 % )形成黄斑裂孔 ,板层裂孔 1眼 ,Ⅱ期裂孔 5眼 ,Ⅲ期裂孔 2眼。裂孔形成组与未形成组的视力、黄斑厚度及玻璃体后脱离的差异不显著 (P >0 0 5 )。结论 :OCT对分析、诊断、监测玻璃体黄斑牵拉具有非常有意义的临床价值。玻璃体黄斑中心凹牵拉是裂孔形成的原因之一     

假性黄斑裂孔的光学相干断层扫描图像特征

目的分析假性黄斑裂孔的光学相干断层扫描(optical coherence tomography,OCT)图像特征。方法收集59例(59眼)假性黄斑裂孔患者,经黄斑中心的垂直和水平线性扫描采集OCT图像,选择符合假性黄斑裂孔的图像,进行裂孔形态、视网膜前膜观察,用随机软件测量裂孔大小、裂孔中央和孔周视网膜厚度,并分析与视力的相关性。结果OCT图像表现为孔周视网膜增厚,视网膜组织内有低反射区,孔底无视网膜组织缺损及孔前盖膜,孔壁形态多样,依孔壁的形态不同分为5型:两侧均为陡峭壁型47眼;一侧陡峭;另一侧倾斜型7眼;两侧向内凹型2眼;一侧陡峭另一侧内凹型2眼;两侧均为倾斜型1眼。明确显示有视网膜前膜34眼。水平及垂直扫描裂孔中央厚度(平均113.3μm和110.0μm)与视力无明显的相关性(r2=0.013,P=0.39;r2=0.002,P=0.727)。裂孔的横径(平均476.5μm)略大于垂直径(平均446.5μm),裂孔呈横椭圆形。结论假性黄斑裂孔与全层或临界黄斑裂孔有不同的OCT图像,孔壁多为陡峭型,部分裂孔显示有视网膜前膜,裂孔中央厚度接近正常,视力下降程度轻。     

特发性黄斑前膜三维光学相干断层扫描图像特征

目的观察特发性黄斑前膜（IERM）的三维光学相干断层扫描（3D-OCT）图像的形态特征,探讨3D-OCT对IERM的诊断价值。方法回顾性分析2009年1月至5月间确诊为IERM的患者35例（40只眼）,行视力、裂隙灯、眼底彩照和OCT检查。OCT检查采用TOPCON3D-OCT1000MARKII,扫描速度27000A扫描/s,扫描面积6.0mm×6.0mm,扫描模式128×512,分析中心凹厚度、中心凹形态及感光细胞（IS/OS）情况。结果IERM的3D-OCT图像表现为视网膜表面薄厚不一的高反光带,绝大多数伴程度不同的中心凹厚度增加。在40只眼中,弥漫性水肿或囊肿20只眼,假性黄斑裂孔3只眼,板层裂孔3只眼,玻璃体黄斑牵拉4只眼,中心凹形态正常者10只眼。结论3D-OCT可提供更多的IERM中心凹形态的信息,在IERM确诊方面有很高的灵敏性。     

光学相干断层成像检查对黄斑疾病的诊断意义

光学相干断层成像(optical coherence tomography,OCT)是近年来发展较为迅速,应用趋于广泛的一种辅助检查技术,目前在眼科领域尤其是眼底黄斑病变的检查中非常重要。我们对其在黄斑裂孔、特发性黄斑前膜、中心性浆液性脉络膜视网膜病变、近视性黄斑病变、黄斑水肿和年龄相关性黄斑变性等疾病中临床表现及诊断意义进行了综述。     

Predicting visual outcomes for macular disease using optical coherence tomography

In recent years, the management of macular disease has undergone radical changes, in part because of new therapeutic approaches, but also due to the introduction of a new imaging modality – optical coherence tomography (OCT). The application of OCT imaging has clarified many aspects of chorioretinal disease pathophysiology and elucidated many hitherto unrecognized disease characteristics. From an early stage in its development, OCT has also been revolutionary in attempting to extract clinically useful measurements from image data in an automated fashion. As a result, OCT-derived measurements of retinal thickness have been rapidly embraced in clinical and research settings. However, as knowledge of OCT image analysis has developed, it has become increasingly clear that even accurate measurements of retinal thickness may fail to predict visual outcomes for many diseases. As a result, the focus of much current clinical imaging research is on the identification of other OCT-derived anatomic biomarkers predictive of visual outcomes – such biomarkers could serve as surrogate endpoints in clinical trials and provide prognostic information in clinical practice. In this review, we begin by highlighting the importance of accurate visual function assessment and describing the fundamentals of OCT image evaluation, before describing the current state-of-the-art with regard to predicting visual outcomes, for a variety of macular diseases, using OCT.Abbreviations: ETDRS, Early Treatment Diabetic Retinopathy Study; MPS, Macular Photocoagulation Study; AMD, age-related macular degeneration; OCT, optical coherence tomography; logMAR, logarithm of the minimum angle of resolution; RPE, retinal pigment epithelium; CNV, choroidal neovascularization; ELM, external limiting membrane; IS–OS, inner segment–outer segment; PED, pigment epithelium detachment; CME, cystoid macular edema; ERM, epiretinal membrane; DME, diabetic macular edema; CRVO, central retinal vein occlusion; BRVO, branch retinal vein occlusion; CSC, central serous chorioretinopathy; GA, geographic atrophy     

光学相干断层扫描血管成像在脉络膜裂伤中的诊断价值

目的:研究光学相干断层扫描血管成像(OCTA)在脉络膜裂伤中的诊断价值,并总结其OCTA影像特征。方法:回顾分析我院确诊为脉络膜裂伤患者的临床资料,共25例25眼,所有患者均接受眼底照相、荧光素眼底血管造影(FFA)、吲哚菁绿血管造影(ICGA)、频域OCT和OCTA检查。结果:所有患者眼底检查可见病灶多位于黄斑区或视盘颞侧,呈弧形黄白色条纹,周围可伴有视网膜脉络膜水肿和视网膜下出血。FFA早期可见裂伤呈弧形透见荧光,晚期荧光着染;当继发脉络膜新生血管(CNV)时,活动性CNV呈高荧光渗漏。频域OCT可见RPE层和脉络膜毛细血管层反射断裂,临近处的组织反射增强,视网膜下可见小团状高反射隆起。OCTA可见脉络膜裂伤的肉芽组织在外层视网膜和脉络膜毛细血管层血流图中表现为具有"条纹形态"的弧形高反射;在断层B扫描(B-scan)中表现为"团状"的向内隆起或向外凹陷,内部具有血流信号。当继发CNV时,在外层视网膜和脉络膜毛细血管层的血流图中可见明确的血管形态,多呈团状,从形态上与脉络膜裂伤的肉芽组织不相同。结论:脉络膜裂伤的修复性肉芽组织与继发性CNV病灶在OCTA中虽然同样呈"团状隆起"并具有血流信号,但两者的形态和组织成分均有明显差异。通过OCTA分层显示以及对病灶细节形态上的观察,可以提高脉络膜裂伤继发CNV的诊断率。     

外伤性黄斑病变光学相干断层成像的应用研究

目的 探讨光学相干断层成像(optical coherence tomography，OCT)在外伤性黄斑病变中的应用。方法 2001年8月—2002年8月临床诊断外伤性黄斑病变16例(16眼)，双眼散瞳行OCT检查，对图像进行分析和测量。结果 全层黄斑孔8眼，板层黄斑孔l眼，黄斑前膜l眼，黄斑区出血3眼，黄斑水肿3眼。结论 OCT在外伤性黄斑病变的诊断、鉴别诊断、病情监测及其发病机制的研究等方面均有重要的意义。     

Retreatment of full-thickness macular hole: predictive value of optical coherence tomography

AIM: To determine whether the efficacy of re-operation for idiopathic full-thickness macular hole (FTMH) remaining open after initial surgery with internal limiting membrane (ILM) peeling is correlated with macular hole configuration as determined by optical coherence tomography (OCT), macular hole size, macular hole duration before the first operation, or type of tamponade (gas or silicone oil). METHODS: A retrospective consecutive interventional case series of 28 patients (28 eyes) with a persisting macular hole after vitrectomy, ILM peel, and gas tamponade. 28 patients underwent repeat surgery involving vitrectomy and gas (n = 15) or silicone oil tamponade (n = 12) or no tamponade (n = 1). Autologous platelet concentrate (n = 22), autologous whole blood (n = 1), or no adjuvant (n = 5) was used. Preoperative OCT was undertaken in all eyes. The main outcome measures were anatomical closure and improvement of best-corrected visual acuity (BCVA). RESULTS: Anatomical closure was achieved in 19 of 28 eyes (68%). BCVA improved in 12 eyes, remained unchanged in nine, and worsened in seven. BCVA improved in 11 of 19 eyes with anatomical closure, and in one of eight eyes without closure. Anatomical closure and improvement of BCVA correlated with preoperative macular hole configuration on OCT, with higher rates of closure (18 of 20 eyes versus one of eight eyes, p = 0.001) and greater improvement of BCVA (p = 0.048) in eyes with a cuff of subretinal fluid at the break margin. Macular hole size, type of tamponade, macular hole duration before the first operation, or preoperative BCVA did not significantly correlate with visual or anatomical outcome. CONCLUSION: Macular hole configuration seems to be a strong prognostic indicator of anatomical closure and may help identify those patients most likely to benefit from re-operation.     

光学相干断层成像对黄斑部视网膜手术疗效的评价

目的：探讨光学相干断层成像(optical coherence tomography，OCT)在黄斑部视网膜手术疗效评价中的作用。方法：应用OCT检查35例35只眼行黄斑部视网膜手术的患者，其中特发性黄斑裂孔23例23只眼，黄斑前膜12例12只眼。于术前和术后2～4周，分别对黄斑裂孔和黄斑前膜形态进行观察，测量裂孔直径、晕轮直径、孔缘厚度。结果：OCT显示黄斑裂孔术后裂孔直径、晕轮直径和孔缘厚度均明显缩小。黄斑前膜术后视网膜厚度在术后2周与术前对比，无显著性差异；术后4周与术前有显著性差异。结论：OCT可定量客观地提供黄斑病变形态学特征，在黄斑部视网膜手术疗效的评价上具有不可替代的作用。     

Diagnosis of vitreoretinal adhesions in macular disease with optical coherence tomography

PURPOSE: To compare the relative incidence of vitreoretinal adhesions associated with partial vitreous separation within the macula diagnosed with optical coherence tomography (OCT) with that of those diagnosed with biomicroscopy. METHODS: The authors obtained linear cross-sectional retinal images using OCT in patients with selected macular diseases. Additional studies included biomicroscopy, fundus photography, fluorescein angiography, and B-scan ultrasonography. RESULTS: Optical coherence tomography was performed on 132 eyes of 119 patients. Vitreoretinal adhesions within the macula were identified using OCT in 39 eyes (30%) with the following diagnoses: idiopathic epiretinal membrane (n = 13), diabetic retinopathy (n = 7), idiopathic macular hole (n = 7), cystoid macular edema (n = 7), and vitreomacular traction syndrome (n = 5). Biomicroscopy identified vitreoretinal adhesions in only 11 eyes (8%). Two distinct vitreoretinal adhesion patterns were identified with OCT, each associated with partial separation of the posterior hyaloid face: focal (n = 25) and multifocal (n = 14). CONCLUSIONS: Optical coherence tomography is more sensitive than biomicroscopy in identifying vitreoretinal adhesions associated with macular disease.     

Diagnostic value of optical coherence tomography for intracranial pressure in idiopathic intracranial hypertension

Background

Idiopathic intracranial hypertension (IIH) is a condition of raised intracranial pressure (ICP) in the absence of space-occupying lesions or other known etiology. It primarily affects young obese females, and potentially causes permanent visual loss due to papilledema and secondary optic atrophy. The aim of this study was to evaluate the diagnostic value of optical coherence tomography (OCT) as a marker for CSF opening pressure in patients with idiopathic intracranial hypertension (IIH).

Methods

We conducted a case-control study of 20 newly diagnosed, 21 long-term IIH patients, and 20 healthy controls. Investigations included measurement of peripapillary retinal nerve fiber layer thickness (RNFLT) and total retinal thickness (RT), automated visual field testing, and measurement of CSF opening pressure. An OCT elevation diagram was developed as a new diagnostic tool. The diagnostic ability of OCT as a marker of increased ICP (> 25 cmH₂O) was investigated using multiple regression and receiver operating characteristic (ROC) curves.

Results

OCT elevation diagrams showed that in 60 % of patients newly diagnosed with IIH and in 10 % of patients with long-term IIH, 50 % or more of the OCT scans (RT and RNFLT) were above normal. The percentage of abnormal OCT scans was significantly associated with increased ICP (p?<?0.0001). Estimated areas under the ROC curves increased from 77.1 to 86.9 by including OCT in multiple regressions. Autoperimetry pattern standard deviation was significantly increased (p?=?0.0005) and mean deviation was significantly decreased (p?=?0.0005) in IIH patients as compared to healthy controls.

Conclusions

Increased peripapillary retinal thickness measured by OCT is associated with increased ICP in newly diagnosed IIH patients. OCT may thus serve as a valuable supplement to subjective assessment of papilledema in patients suspected of having IIH. In long-term IIH patients who have previously been treated, OCT appears to be of limited value in predicting ICP.